Ankle Sprains and Ankle Pain
An ankle sprain is an injury to one or more ligaments on the side of the ankle. Ligaments, as you may know, connect bone to bone–usually across joints. Ligaments are bands of elastic tissue which allow motion but also provide resistance. They are particularly important in the ankle because they provide stability. Most often, ankle sprains deal with the three ligaments on the outside of the ankle. But they can also refer to an injury on the inside part of your ankle and between the two leg bones in your lower leg.
Some ankle sprains are worse than others. Severity depends upon which ligaments are involved, as well as the degree of injury, such as partial or complete rupture. On the outside of the ankle, let’s call them ligaments No. 1, No. 2, and No. 3. This is typically the order in which they are injured, from front to back. One is easy to injure, as it is the weakest and smallest. Two takes a bit more effort to rupture, while No. 3 usually involves a significant injury. On the inside of the ankle, the ligament has a cooler name, the deltoid. It is comprised of many smaller ligaments, but is quite strong and resistant to injury. The inter-osseous ligament is, you guessed it, between the tibia and fibula. Think Terrell Owens and his injury before the Superbowl when he broke his leg. Amazingly, he was able to play high-level competitive sports just seven weeks after having surgery to repair the fracture and the ligament rupture! As a disclaimer, if he were my patient, I wouldn’t have let him play. And I hate the Patriots, being a Dolphins fan.
Sprained ankles often result from a sudden twisting injury or blow that forces the ankle out of its normal, aligned position. Sprains most commonly occur from sports, inappropriate shoes or walking/running on an uneven surface. Also, certain individuals can be predisposed to weak ankles, especially if a prior injury history exists. This is because the normal rubber-band like elasticity of the ligament is not the same after an injury. As a result, the ligament heals back in position, but with less elasticity and more scar tissue. Scar tissue is not nearly as elastic or forgiving as normal ligamentous tissue. The next ankle sprain becomes worse, and it takes less effort and energy to create.
Signs and Symptoms
Common signs of injury are ankle pain, swelling, bruising, difficult walking, or bearing weight, as well as joint stiffness. Significant bruising, encompassing the entire outside leg and bottom of the foot, often indicates a fracture, not just a sprain. These symptoms vary in intensity, depending upon the severity of the injury.
RICE RICE, baby! Rest, Ice, Compression, Elevation. Easy to remember, thanks to the Vanilla Ice song, and is exactly what I would do if one of my family members injured their ankle. Other important treatments are medication, immobilization, and early physical therapy. After taking X-rays to rule out more serious issues, I place my patients in an ankle sleeve as well as a boot. Normal healing time, for a simple sprain, is six to eight weeks. Sometimes, operative repair is warranted, but this is often seen with chronic ankle instability, not the initial acute-type rupture. It is important to seek treatment promptly because an ankle sprain often is progressive and leads to more serious ankle sprains down the road. This could result in instability, which can indefinitely sideline the average person.
Dr. Kennedy Legel
As Featured in ‘D’ Magazine